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HomeMy WebLinkAboutApproved Septic and Well PermitSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Raymond Causley PROPERTY ADDRESS: TBD Tree Top Trl Fort Pierce, FL 34951 LOT BLOCK: PROPERTY ID # : 1407-342-0035-000-7 SUBDIVISION: PERMIT #:66-SF-2268399 APPLICATION #: AP1653196 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1579061 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 1,050 ] GALLONS / GPD Septic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 667 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [x] FILLED [I FUND [ ] I CONFIGURATION: [ ] TRENCH [x] BED [ ] N F LOCATION OF BENCHMARK: CL Of Rd @ N PL extended E I ELEVATION OF PROPOSED SYSTEM SITE [ 2.00 ][INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 1.00 ][INCHES FT ][ABOVE BELOW]BENCHMARK/REFERENCE POINT L D O T H E R REQUIRED: [7/.UU] INCHES EXCAVATION REQUIRED: [ 4U.UU] INCHES system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of gpd. SPECIFICATIONS BY: Ian P Moo TITLE: CEHP 19-2072 APPROVED BY: TITLE: Environmental Specialist III Brian J I am DATE ISSUED: 06/07/2021 EXPIRATION DATE DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC v 1.1.4 AP1653196 SE1524489 St. Lucie CHO 12/07/2022 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. HEALTH PAYING ON: RECEIVED FROM: PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 #. 56-SF-2268399 BILL DOC #:56-BID-5242423 CONSTRUCTION APPLICATION #. AP1653196 Reliable Septic & Service AMOUNT PAID: $ 545.00 CREDIT CARD 042426 PAYMENT DATE: 04/05/2021 MAIL TO: Raymond Causley FACILITY NAME: PROPERTY LOCATION: TBD Tree Top Td Fort Pierce, FL 34951 Lot: Block: Property ID: 1407-342-0035-000-7 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 -1 - Well Construction 1 $ 115.00 RECEIVED BY: EvansJS AUDIT CONTROL NO. 56-PID-4937349 Note: W/ Well# 59-31779 STATE OF FLORIDA PERMIT NOS5'- ??'Z DEPARTMENT OF HEALTH DATE PAID: ONSITE SEWAGE TREATMENT AND DISPOSAL FEE PAID: SYSTEM RECEIPT # : Z L L 4we° ''� APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [�] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary [ ] APPLICANT: Raymond F Causley AGENT: Reliable Treasure Coast Services Indian River Septic MAILING ADDRESS: PO Box 1116, Vero Beach FL 32961 TELEPHONE: (772) 562-4242 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: Metes and Bounds PROPERTY ID # : 1407-342-0035-000-7 ZONING: AR-1 PROPERTY SIZE: 1.15 ACRES WATER SUPPLY: [,,] PRIVATE IS SEWER AVAILABLE AS PER 381.0065, FS? [ A ] PLATTED: Pre-72 I/M OR EQUIVALENT: [ N ] PUBLIC [ ]<=2000GPD [ 1>2000GPD DISTANCE TO SEWER: N/A FT PROPERTY ADDRESS: Parcel ID: 1407-342-0035-000-7, ree Top Trail, Ft. Pierce FL 34951 DIRECTIONS TO PROPERTY: BUILDING INFORMATION Unit Type of No Establishment 1 Single Family 3 4 [,e] RESIDENTIAL [ ] COMMERCIAL No. of Building Commercial/Institutional System Design Bedrooms Area Sqft Table 1, Chapter 64E-6, FAC 3 2545 [ ] Floor/Equipmeinp'Drains [ ] Other (Specify) SIGNATURE: DATE: 3/30/21 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 40W STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATIONS PERMIT #. APPLICANT: Raymond F Causlev AGENT: Reliable Treasure Coast Services Indian River LOT: BLOCK: SUBDIVISION: Metes and Bounds PROPERTY ID #: 1407-342-0035-000-7 [Tax ID Number 0] TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE,OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: IV] YES [ ] NO NET USABLE AREA AVAILABLE: 1.15 ACRES TOTAL ESTIMATED SEWAGE FLOW: 400 GALLONS PER DAY (RESIDENCES-TABLEI 0i AUTHORIZED SEWAGE FLOW: 1725 GALLONS PER DAY 11500 GPD/ACRE UNOBSTRUCTED AREA AVAILABLE: 750 SQFT UNOBSTRUCTED AREA REQUIRED: 750 SQFT BENCHMARK/REFERENCE POINT LOCATION: Centerline of Road at the North Prc ELEVATION OF PROPOSED SYSTEM SITE I52 [INCHES [ABOVE BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER:N/A FT DITCHES/SWALES:137 FT NORMALLY WET? [ I YES IV] NO WELLS: PUBLIC: N/A FT LIMITED USE: N/A FT PRIVATE:120 FT NON -POTABLE: N/A FT BUILDING FOUNDATIONS:5 FT PROPERTY LINES:20 FT POTABLE WATER LINES:108 FT SITE SUBJECT TO FREQUENT FLOODING: [ I YES [,,J NO 10 YEAR FLOODING? ( ] YES I✓] NO 10 YEAR FLOOD ELEVATION FOR SITE: FT MSL/NGVD SITE ELEVATION: FT MSL/NGVD bu1L MUNSELL #/COLOR 10YR 4/2 10YR 4/1 10YR 5/1 10YR 2/1 1OYR 3/6 ORMATION SITE 1 TO TO TO TO TO TO USDA SOIL SERIES: Tantle Sand -Like TEXTURE S S S Spodic FS Refusal @ 59 .10 iNC ViCl7lil-1VlV .71TL'G DEPTH 0 To 7 7 TO 29 26 To 29 29 TO 40 40 TO 62 TO TO TO TO USDA SOIL SERIES: Tantile Sand -Like TEXTURE S S S Spodic FS Refusal (a, 62 OBSERVED WATER TABLE:41 INCHES [BELOW �] EXISTING GRADE. TYPE: APPARENT [j]] ESTIMATED WET SEASON WATER TABLE ELEVATION:25 INCHES [.BELOW] EXISTING GRADE HIGH WATER TABLE VEGETATION: [ ] YES IV) NO MOTTLING: [V] YES [ J NO DEPTH:25 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING:Sand/.8 DEPTH OF EXCAVATION:40 INCHES DRAINFIELD CONFIGURATION: [VI TRENCH [ ]'BED ( ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA: S H S determined by >10% 10YR 5/1Atripping in a 10YR 4/1 matrix at 25 inches in site 1 Refusal due to saturation in both sites. Revised due to tvnn R11191 SITE EVALUATED BY: Ian Moore C.E.H.P. 19-2072 DATE: 3/30/21 DR 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 P& Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TREE TOP Parcel ID: 1407-342-0035- Account #: 6293 Sec/Town/Range: 07/34S/40E TRL 000-7 Map ID: 14/07S Zoning: AR-1 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Raymond F Causley 7 34 40 N 1/2 OF SE 1/4 OF NW 1/4 OF SE 1/4 OF SW 1/4- Ami Jo Causley LESS E 30 FT (1.15 AC) 8406 Deland AVE Fort Pierce, FL 34951 Current Values Historical Values 3-year Just/Market: $36,200 Assessed: $36,200 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $36,200 2020 $36,200 $36,200 $0 $36,200 2019 $36,200 $30,855 $0 $30,855 2018 $30,200 $28,050 $0 $28,050 Sale History Date Book/Page Sale Code Deed Grantor 12-30-2019 4364 / 2618 0001 WD Fountain Wendell 06-27-2002 1548 / 2637 XX00 WD Brookes Duane W 06-07-2001 1413 / 2145 XX01 WD Brookes Duane W Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Year Built: N/A Frame: Grade: Primary Wall: Story Height: No. Units: 0 Interior Data Bedrooms: 0 A/C %: 0% Electric: Full Baths: 0 Heated %: N/A% Heat Type: Half Baths: 0 Sprinkled %: 0% Heat Fuel: Type Total Areas Building Type: Effective Year: N/A Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Finished/Under Air (SF): Gross Sketched Area (SF): Land Size (acres): Land Size (SF): Total Building Count: Special Features and Yard Items Qty Units Year Blt Price $55,000 $8,000 $100 0 0 1.15 50,094 1 All information is believed to be correct at this time, but is subject to change and is provided without any warranty. 0 Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved. Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Fioricta HEALTH Vision: To be the Healthiest State in the Nation Ron DeSantis Governor Scott A. Rivkees, MD State Surgeon General Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits Effective July 24, 2017 • Contact the Florida Department of Health in Saint Lucie County (FDOH — St. Lucie) prior to constructing or abandoning any well. a. Call the FDOH — St. Lucie Well Line at 772-873-4936 or email SLCDOH-WELLS(cD.FLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment • A minimum of 24 hours' notice is required before constructing any public water supply wells. Please call our main office at 772-873-4931 and speak with Environmental Health Staff or provide notification by email to SLCDOH-WELLS(�FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health St. Lucie County 5150 NW Milner Drive • Port St Lucie, FL 34983 PHONE- 772/462-3800 • FAX: 772/871.5360 StLucieCountyHealth.com Accredited Health Department • : Public Health Accreditation Board STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL O Southwest ❑ Northwest PLEASE FILL OUT ALL APPLICABLE FIELDS ('Denotes Required Fields Where Applicable) ❑St. Johns River ElSouth Florida The waferwellcantmcGuisresponsible for completing []Suwannee River tots lam and forwarding the pernift application to the appropriate delegated authority where applicable. ❑ DEP ❑ Delegated Authority (If Applicable) 5r-22pi 3Ogq Permit No. 59-31779 Florida Unique ID Permit Stipulations Required (See Attached) 82-524 Quad No. Delineation No. CUPAMUP Application No. ABOVE THIS LINE - FOR OFFICIAL USE ONLY 1. Raymond & Ami Jo Causley 8406 Deland Avenue, Fort Pierce, FL 34951 772-201-2708 *Owner, Legal Name if Corporation *Address *City *State 'ZIP Telephone Number 2, Tree Top Trail, Fort Pierce, FL *Well Location - Address, Road Name or Number, City 3,1407-342-0035-000-7 *Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4.07 34S 40E St Lucie Check if 62-524 ❑ Yes ❑ No *Section or Land Grant Township *Range 'County Subdivision 5, Scott's Drilling, Inc. 11213 772-489-6117 scottsd6lling@bellsouth.net *Water Well Contractor License Number *Telephone Number E-mail Address 6, 5014 Palm Drive Fort Pierce FL 34982 "Water Well Contractor's Address City State ZIP 7. *Type of Work: Fv Construction ❑ Repair ❑ Modification❑ Abandonment 8. *Number of Proposed Wells ONE *Reason for Repair, Moalyc€tl t 9. *Specify Intended Use(s) of Well(s): (/,�� C Domestic R Landscape Irrigation ® Agricultural Irrigation ❑ Site Investigations Bottled WaterSupply Recreation Area Irrigation Livestock Monitoring Public Water Supply (Limited Use/DOH) Nursery Irrigation Test JUN 7 2021 Public Water Supply (Community or Non-Community/DEP) Commercial/Industrial Earth -Coupled Geothermal Class I Injection Golf Course Irrigation HVAC Supply HVAC Return lass V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage F OH in St Lucie Count, 2emediation: ❑ Recovery[] Sparge ❑ Other (Describe) EN 110� 1 EALI %Other (Describe) L. kistence from Septic System if S 200 ft. 112_ 11. Facility Description ing a F mily Residence 12. Estimated Start Date "Estimated Well Depth 120 ft. *Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To ft. 14. Estimated Screen interval: From 100 To 120 f, 15.*Primary Casing Material: Black Steel Galvanized PVC Stainless Steel Not Cased Other: 16. Secondary Casing: Telescope Casing Liner Su • e Casing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18.*Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted �( Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) t (Direct Push) Horizontal Drilling Plugged by Approved Method Other (osscribe) 19. Proposed Grouting Interval for the Primary, Secondary, and Ad�11LCe:e l . From 0 To 100 Seal Material ( Bentonit/� NeaOther ) From To Seal Material ( Bentonite ent Other } From To Seal Material ( Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other ) 20. Indicate total number of existing wells on site List number of existing unused wells on site 21.*Is this well or any existing well or water ��N the owner's contiguous propelly covered under a Consumptive/Water Use Permit (CUP/WUP) or CUPNVUP Application Yesyes, complete the following: CIJPANUP No. District Well ID No. 22. Latitude 23. Data Obtained From: GPS Map Survey I hereby canary Uoat 1 wig comply with the oppncable ndas of Title W. Florida Adminisirobve Ccdu. anti dart a wador use parul or arunaal radrwga permit, if needed, has been or will be obtained Prlor to cairmamerwit of wen eomliucnan. I Wither wdiy that all information provided in this application Is acranalo and that I will obtain nocewary approval from Other federal, wore, or local governments 11 applicable. 1 agree to prov;de a well awroplolion report to the District vdthln 30 days after mirminoon of the conctruceon, repair, rmrllnrntion, or abandonment authorized b1 this peant, or the paring espirsdon, whlo:over pears that. 11213 *Signature of Contractor _ *License No. Approval Granted Fee Received S Receipt No, Issue Datum: NAD 27 NAD 83 WIGS 84 I comfy that 1 am the e,mer at the properly, that the infwnmion piwAded is amurale, and that 1 am resptmMudre Monsu A atamlas, to maintain or Properly abanlon tltk well. or, I the spn gawldad lo aearate, and ar nsonts to anoMrg of 0, IM.:D vaekga rospa Ur, rrwQnatlon,. or ndanrronf auUrodmd M Iftls pen of Owner* Agent Expiration Date (y /1 w"1 Hydrologist Approval Check No. meals of I ate r aeoesa THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. e I \ i x U! f1. N \ x 0 t1 N 0 o x I m 0\ N ru \ w c \ x 0 1 IJ� p Ut V C a v x 0 N (A r _ < N ;u ;a Tp I m N� 0 to a: p S r- a, D Z Z r•{ �`� 30100� q x v e - p � � a v Z 0 Z lif.00' 0co co a i CD e' CA J V Ql � Q � •{ i1 20.7 ' ° n w-nm;U �_ O O ry p Cl) o m --�n m��z =! c b. N n{ m 0 D co 3JOl' • •/ L �� ' v x D a • �4 t N I/� / °• 4 �1% X -00 � Q 4 m ru O ° O •a b 6i• �. b 4 ,. o, , p .. .. ,.•L iR ° ,Jd c `� {. { ) t'� cr, Xi •' x I a x � .•• 'o ry 50'B.S.L. Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TREE TOP Parcel ID: 1407-342-0035- Account #: 6293 Sec/Town/Range: 07/34S/40E TRL 000-7 Map ID: 14/07S Zoning: AR-1 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Raymond F Causley 7 34 40 N 1/2 OF SE 1/4 OF NW 1/4 OF SE 1/4 OF SW 1/4- Ami Jo Causley LESS E 30 FT (1.15 AC) 8406 Deland AVE Fort Pierce, FL 34951 Current Values Historical Values 3-year Just/Market: $36,200 Assessed: $36,200 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $36,200 2020 $36,200 $36,200 $0 $36,200 2019 $36,200 $30,855 $0 $30,855 2018 $30,200 $28,050 $0 $28,050 Sale History Date Book/Page Sale Code Deed Grantor 12-30-2019 4364 / 2618 0001 WD Fountain Wendell 06-27-2002 1548 / 2637 XX00 WD Brookes Duane W 06-07-2001 1413 / 2145 XX01 WD Brookes Duane W Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Year Built: N/A Frame: Grade: Primary Wall: Story Height: No. Units: 0 Interior Data Bedrooms: 0 A/C %: 0% Electric: Full Baths: 0 Heated %: N/A% Heat Type: Half Baths: 0 Sprinkled %: 0% Heat Fuel: Type Total Areas Building Type: Effective Year: N/A Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Finished/Under Air (SF): Gross Sketched Area (SF): Land Size (acres): Land Size (SF): Total Building Count: Special Features and Yard Items Qty Units Year Bit Price $55,000 $8,000 $100 0 1.15 50,094 1 All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved. HEALTH PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 # 56-SF-2268399 BILL Doc # 56-BID-5242423 CONSTRUCTION APPLICATION #. AP1653196 Reliable Septic & Service AMOUNT PAID: $ 545.00 CREDIT CARD 042426 PAYMENT DATE: 04/05/2021 MAIL TO: Raymond Causley FACILITY NAME: PROPERTY LOCATION: TBD Tree Top Trl Fort Pierce, FL 34951 Lot: Block: Property ID: 1407-342-0035-000-7 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 -1 - Well Construction 1 $ 115.00 RECEIVED BY: EvansJS AUDIT CONTROL NO. 56-PID-4937349 Note: W/ Well# 59-31779